Healthcare Provider Details

I. General information

NPI: 1114867397
Provider Name (Legal Business Name): SURGEONACCESSSURGEONACCESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 UNIVERSITY HEIGHTS AVE
BOULDER CO
80302-6814
US

IV. Provider business mailing address

2490 UNIVERSITY HEIGHTS AVE
BOULDER CO
80302-6814
US

V. Phone/Fax

Practice location:
  • Phone: 484-684-5287
  • Fax:
Mailing address:
  • Phone: 484-684-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: BLAINE WARKENTINE
Title or Position: CEO
Credential: MD
Phone: 484-684-5287